Resuscitation
Resuscitation from drowning was successfully accomplished by a
variety of methods as early as 1792, when James Curry[429]
used digital intubation of the trachea and forced air into the lungs with a bellows
(see Chapter 78
). J. Leroy
attacked the use of positive pressure with bellows as a dangerous procedure in 1827
by showing it could rupture the alveoli and produce fatal tension pneumothorax.[430]
Consequently, several ineffectual techniques developed, such as administration of
stimulating vapors, swinging the arms up and down, and pulling the tongue forward
in a rhythmic motion,[431]
and these futile
techniques were slow to dissipate. Largely through the work of O'Dwyer, Tuffier,
and Matas, positive-pressure methods were reintroduced in the first few decades of
the 20th century. James O. Elam (1918–1995) instinctively demonstrated the
efficacy of mouth-to-mouth ventilation in 1946 when ventilators were in short supply
during the polio epidemic. Peter Safar (1924–2003) and Elam were influential
in converting the teaching of the ineffectual arm-lift method to mouth-to-mouth breathing
techniques by demonstrating the proficiency of the later technique on volunteer medical
students.[432]
[433]
Rational methods of resuscitation from full cardiac arrest awaited
the development of the electrocardiogram and its interpretation. Augustus Waller
[434]
(1856–1922) first produced tracings
of
the electrical activity of the heart in 1887, but Willem Einthoven[435]
(1860–1927) is credited with producing the first modern electrocardiogram using
a string galvanometer in 1903. Tracings compatible with occlusion of the main coronary
vessels were demonstrated first in animals and then confirmed in patients by James
B. Herrick[436]
(1861–1954) of Chicago. John
MacWilliam[437]
(1857–1937) described ventricular
fibrillation in 1887 and provided a case report showing it to be the cause of death
in one subject.[438]
In 1899, J. L Prevost and
F. Battelli[439]
showed that small electrical currents
passed across the heart could induce ventricular fibrillation and that larger currents
could convert fibrillation to a normal rhythm. Claude Beck[440]
performed the first successful use of electric defibrillation in a patient in 1947.
Open cardiac massage was first performed in Norway in 1901[433]
and in the following year by Starling,[441]
and
external massage over the chest was described by W. W. Keen in 1904.[442]
Brief anecdotal reports had been presented on closed chest massage as early as 1883
by Franz Koenig of Göttingen, Germany.[443]
William B. Kouwenhoven, Dean of the School of Engineering at Johns Hopkins from
1939 to 1953, began his studies on resuscitation from cardiac arrest in 1929 and
31 years later published the full sequence of external cardiac massage, combined
with electric countershock, to restore cardiac rhythm.[444]
These methods of resuscitation have been promoted by the American Heart Association
and, with some modifications, have become the basis for the widely disseminated educational
programs of advanced cardiac life support (ACLS).
